Published Online
on July 22, 2009

A more recent version of this article appeared on August 1, 2009

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Original Articles

Effect of High-Dose Intracoronary Adenosine Administration During Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

A Randomized Controlled Trial

Marieke L. Fokkema, BSc; Pieter J. Vlaar, MSc; Mathijs Vogelzang, MD, PhD; Youlan L. Gu, MD; Marthe A. Kampinga, MD; Bart J. de Smet, MD, PhD; Gillian A. Jessurun, MD, PhD; Rutger L. Anthonio, MD, PhD; Ad F. van den Heuvel, MD, PhD; Eng-Shiong Tan, MD, PhD and Felix Zijlstra, MD, PhD

From the Thoraxcenter, Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Correspondence to Marieke L. Fokkema, BSc, Hanzeplein 1, PO Box 30 001 9700 RB Groningen, The Netherlands. E-mail m.l.fokkema{at}thorax.umcg.nl

Background—Coronary microvascular dysfunction is frequently seen in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. Previous studies have suggested that the administration of intravenous adenosine resulted in an improvement of myocardial perfusion and a reduction in infarct size. Intracoronary adenosine (bolus of 30 to 60 µg) is a guideline-recommended therapy to improve myocardial reperfusion. The effect of intracoronary adenosine during primary percutaneous coronary intervention has not been investigated in a large randomized trial.

Methods and Results—Patients presenting with acute ST-elevation myocardial infarction were randomized to 2 bolus injections of intracoronary adenosine (2x120 µg in 20 mL NaCl) or placebo (2x20 mL NaCl). The first bolus injection was given after thrombus aspiration and the second after stenting of the infarct-related artery. The primary end point was the incidence of residual ST-segment deviation <0.2 mV, 30 to 60 minutes after percutaneous coronary intervention. Secondary end points were ST-segment elevation resolution, myocardial blush grade, Thrombolysis in Myocardial Infarction flow on the angiogram after percutaneous coronary intervention, enzymatic infarct size, and clinical outcome at 30 days. A total of 448 patients were randomized to intracoronary adenosine (N=226) or placebo (N=222). The incidence of residual ST-segment deviation <0.2 mV did not differ between patients randomized to adenosine or placebo (46.2% versus 52.2%, P=NS). In addition, there were no significant differences in secondary outcome measures.

Conclusions—In this randomized placebo controlled trial enrolling 448 patients with ST-elevation myocardial infarction, administration of intracoronary adenosine after thrombus aspiration and after stenting of the infarct-related artery did not result in improved myocardial perfusion.

Key Words: myocardial infarction • adenosine • angioplasty • reperfusion